At least once a week, the clinic where I work turns down a massage client because he or she is taking blood thinners. Often, it breaks my heart to turn them away, since most of these people are seniors. Last week, after I informed one lady that I couldn't give her a massage because of her medication, she told me that she was coming to me because another client had recommended me. I felt about 4 feet tall. Then she told me that the reason she came in that day was because she had just dropped off her husband at the hospital -- he was getting chemotherapy for cancer. She thought getting a massage would be a good way for her to deal with it. I felt about 2 feet tall. Is there nothing we can do for these people other than to throw them out into the street? Is every blood thinner a contraindication? For some reason, I thought Coumadin was an exception. Also, isn't aspirin also a blood thinner? Should we turn away everyone who takes aspirin? We'd have no clients left if we did that.

We are all in the gutter, but some of us are looking up at the stars - Oscar Wilde

Blood thinners are contraindicated for deep tissue massage, but if a person has been on them awhile and is stable - no serious bruising with even gentle touching - then a light or medium swedish is just fine. Other things that are okay would be stretching, gentle compressions, lymphatic drainage massage, among others. The big thing is for it to be gentle and non-bruising. I work mainly with seniors. If you or the owner/manager of the place are just too uncomfortable, then make sure that question is part of the phone intake procedure and have a form ready to send/give them requesting a physician's release. Walk ins would still be tricky, but you could ask them to get it and come back later in the day - and even have them on the schedule, which could have the added benefit of starting to train them to make appointments ahead of time.

We were always taught that Blood Thinners were a partial contraindication. No deep work (especially no deep spot work) - but light massage, as Sharon suggested, is OK.

Have you talked with the Clinic owner about why they insist on simply turning away clients on blood thinners?? Uncomfortable, liability?? OR maybe a bad previous experience?

We pretty much have a policy (as well as I was taught in school) To explain to the client what problems could arise from their medication and massage, which modifications would be made so the complications won't be an issue - and then give them the option of continuing or deciding not to have a massage.

I would discuss this with the owner, if you can (and want to!) - and maybe ask about accepting them on a case-by-case basis, and like Sharon suggested as well, ask for a physician's release. I can definitely understand turning away someone who wants deep work and deep spot work. But the woman you mentioned in your post probably just needed a caring touch and a place to to feel safe and escape for an hour.

I have not spoken to the owner, who is rarely on site. But I have approached the manager who said that he has strict instructions from the owner. I believe the issue is fear of liability. But I am not even allowed to do manual lymphatic drainage. Once such client who was turned away had obvious edema in both legs. I offered to do MLD for him and was not allowed to do so. The manager said the his condition indicated thrombosis in the legs. MLD, if done right, would not affect blood flow, but I really can't argue-- I am not a doctor. I just felt bad for the guy, who walked away saying "So you're telling me I can never have a massage for the rest of my life?"

We are all in the gutter, but some of us are looking up at the stars - Oscar Wilde

Ugh. It sounds like convincing them to get a physician's release is by far the best way to go about it, but sounds like even that would be extremely difficult, as they are sounding quite inflexible. There is nothing like an unsubstantiated list of contraindications combined with fear to shoot the potential client list!

Sounds like the owner needs a bit of education into the practical side of turning away individuals with partial contraindications --- bad pr which will certainly result from such strict guidelines.

Clients w/ heart problems, blood clots in legs, etc. and on coumadin, etc. have been in my practice since day one. Doctors have told them to NOT have deep tissue work, but, to have massage for relief of symptoms and stress relief, if nothing else. I have learned through trial and error and many client requests how to adjust my pressure and techniques for each person individually. One lady bruises so easily that even breathing on her skin can cause a bruise. Does she eschew massage when she hurts and the spasms in her neck and legs are horrendous? Not hardly!! She's on the phone to me asking for a 1/2 hour of gentle massage with lots of lotion - which for her keeps down the bruising and helps her body release the tensions that are causing the spasms. For another person, it's a blend of Reiki, ortho-bionomy and swedish work with a moderate touch that saves the day every time.

These clients have all told their doctors they are receiving massages and the doctors have encouraged it because it does increase their circulation, improves skin tone, etc and it relieves their mental stressors as well.

One question for you - how does the front desk know about the contraindications? Do the people there do all of the intake for you and then make decisions about who will and won't be allowed to have massages? On one hand that would save therapists time, yet, on the other, it could [and obviously has] turn away business for people who definitely could use it and income for the therapists [and the owner.]

Anastasia B

Be who you are and say what you feel, because people who mind don't matter, and people who matter don't mind. - Theodore S. Geisel - [Dr. Seuss][

Obviously, I have no way of knowing how many blood thinner patients are turned away when they call for an appointment. This is Florida, after all, so I assume there are many such cases due all the seniors here. Maybe once every other week I hear of a patient who goes in for a chiropractic evaluation and is told they can't get massage. And just as often, one slips through these stages of triage and I'm the one who ends up telling them I can't treat them. I look at their intake form and if there is a medication I don't recognize I either ask the doctor if he's familiar with it or I ask the patient directly if he or she is taking blood thinners-- they are always honest. Strange thing is that the doctor who is on-site is not in favor of this policy, but he is not the owner. And, yes, if the client gets to me by the time we make the decision to turn them away, I lose the time in income. (But that's also true for all insurance patients who decide not to show up-- I end up paying for it-- that's a different topic for another time-- one I hope to work with my local massage association to rectify by legislation.)

We are all in the gutter, but some of us are looking up at the stars - Oscar Wilde

I would like to suggest that blood thinners, as with any medications, that they are an indication that more information is required before you can decide what you may or may not be able to do. The other consideration I would like to add is that everything has risks, including any and all massage, as in everything in life. What I learned from Ruth Werner, whom I consider the definitive expert in pathology regarding massage, is that the benefits and the potential risks need to be considered before a treatment plan is established. And, that may include using a reference source, such as a book on pathology, or contacting the client's doctor. In any case, you can always do energy work, no matter what condition they have or what medication they are taking.

In the case of the lady on blood thinners with her husband getting chemotherapy, an energy massage might just have been the best thing for her. Remember, a contraindication is a caution sign, it is not a stop sign. Always seek to do the most amount of good with the least possible chance of harm. I say this because I have experience with massage in a cancer treatment center and with some patients we would just sit and let them talk to us, that in itself was enough to relieve some of their discomfort and anxiety. Even just sharing space with someone, without touching them, is therapeutic, and we are therapists. We are limited only by our imagination on how to best offer comfort to others, touch just happens to be the method in which we received training to get our licenses, but thinking outside the box, if you will, and improvising goes beyond just the craft and turns in into artwork. If you think in those terms, you will never have to turn somebody away, that does not need to happen, because that would break my heart as well and make me feel two foot tall. I prefer to keep my heart in one piece and feel ten feet tall. My mentor, Bill Mueller, always told me to use everything as a learning experience. Let's all use this conversation thread for that purpose, and hopefully, more people will receive the therapy that they deserve, and we can supply.

Today I saw a client for the first time. She has had multiple MVAs and suffered severe chronic pain since 1989. She has been on Warfarin (a blood thinner) since last summer due to tearing in her vertebral arteries. Last week she was in another MVA and suffered more whiplash and low back injuries. She was referred to me by her chiropractor for soft tissue work.

For this session, I kept her comfortably supine the entire time, and focused on her neck, upper back, shoulders, chest, and low back. The only modalities I used were positional release technique (PRT) and dermoneuromodulation (DNM). I even avoided gliding strokes. By the end of our session, she had much less pain, more neck and shoulder ROM, and was moving with greater ease and confidence. She was very happy, and I was glad to have given her some relief without any added risk of complications.

If I was competent in MLD, I might have used that, too. If it seems indicated, I will refer her to another MT for that kind of work. It would pose little/no risk to her.